FAQ: Visualase Thermal Ablation for Epilepsy

UCSF is one of the only centers in the nation to offer a cutting-edge laser surgery treatment for adult and pediatric epilepsy. With this new technique, a laser fiber is guided toward the source of a patient's seizures through a small hole in the skull. The laser heats and destroys the small, well-defined area of abnormal brain tissue, leaving the surrounding tissue unharmed. The entire procedure is viewed in real time on MR images that show thermal maps displaying the distribution of heat to ensure safety and successful target treatment.

For certain patients, using laser ablation for treating seizures can be as or more effective than other therapeutic options, with less risk.

MR-guided laser thermal ablation is an exciting new option for patients with epilepsy that increases both safety and efficacy. UCSF has the largest experience with laser ablation for epilepsy in the Bay Area and has done more procedures for pediatric epilepsy patients than any center in California.

Who is a candidate for Visualase laser thermal ablation?

Any patient with medically refractory epilepsy and MRI-visible lesions that have been confirmed as the source of the epilepsy are currently suitable candidates for laser thermal ablation therapy.

What are the advantages over other types of epilepsy surgery?

Laser ablation is performed through a small ‘nick’ scalp incision and hole in the skull as opposed to an extensive scalp incisions and large cranial opening that is typical of standard epilepsy surgery. The treatment time and recovery time are both dramatically faster. In the event that the procedure incompletely treats a patient’s epilepsy, repeat treatments are equally straightforward and well-tolerated.

What are the potential risks or side effects?

Although thermal ablation is a minimally invasive surgery, there are some risks. Treatment success is completely dependent on accurate placement of the laser fiber into the target lesion. Inaccurate placement of the laser is a potential risk and therefore injury to fragile or sensitive structures nearby is possible. For that reason, the majority of the treatment time is meant to ensure the accuracy of laser placement prior to initiating ablation. As with any brain procedure, there are risks of bleeding and infection, but these are always proportional to the size of the surgical exposure, treatment time and depth of treatment, all of which are lessened with laser therapy compared to open cranial surgery.

How long will the treatment take?

The actual laser ablation treatment time is on the order of minutes. Set-up time and laser fiber placement can be 3-4 hours.

How long will I be in the hospital?

The majority of patients spend one night in the hospital and are discharged the following day.

Will my seizures be cured?

The Visulase laser ablation system was approved by the FDA in 2010. Given that this technology is new, the long-term outcomes from laser ablation therapy are not completely known. Preliminary findings indicate that a large proportion of patients experience immediate improvement or control and that these results have lasted many months to at least 1 year. Further studies are ongoing to track long-term outcomes. The most likely outcomes will depend largely on the type of epilepsy, the kind of lesion that is the source of their epilepsy and the details surrounding their particular laser treatment.

Who should I contact for an evaluation?

For more information or to find out if you are eligible for Visualase thermal ablation therapy, contact the Epilepsy Center at (415) 353-2437. Your medical records can be reviewed to determine whether you are a candidate or you may undergo further evaluation by an epileptologist specializing in medically refractory epilepsy.

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